Sjögren’s (pronounced SHOW-grins) syndrome is far from a minor irritant for many of those affected. Chronic and progressive, it can cause a wide variety of symptoms. Because Sjögren’s attacks glands that provide moisture, its symptoms can include dry eyes and mouth, eye pain, blurry vision, burning mouth, loss of taste, rampant tooth decay and difficulty swallowing.
Very often, the syndrome also causes fatigue, joint and muscle pain, rashes and brain fog. Plus, there can be complications, including lung or kidney inflammation. And those with Sjögren’s can have a 15 to 20 times higher risk of developing lymphoma, a form of blood cancer, than those without it.
Striking up to 10 in 10,000 people —the vast majority of them women around menopause age—Sjögren’s is not only frequently minimized, it’s one of the most difficult autoimmune conditions to diagnose and treat.
Diagnostic challenges: An accurate diagnosis can help pinpoint how severely a patient is affected…and estimate the patient’s risk for lymphoma. Unfortunately, the symptoms of Sjögren’s often don’t help with getting a proper diagnosis, as many are common to other health conditions. And no single test can diagnose it. Useful diagnostic tests that can be underutilized…
• An array of antibody blood tests is the best starting point, since the majority of patients have antibodies that support the diagnosis. However, the antibody tests alone are not sufficient.
• An eye exam that includes special tests.The Schirmer test measures tear flow. And the ocular surface stain test assesses damage to the surface of the eye due to dryness.
• In-office biopsy of the tiny salivary glands inside the lip. This is an essential test to confirm Sjögren’s if the antibody tests are negative. The simple procedure, which involves a shallow incision to remove four to seven glands for analysis, is best done by an oral surgeon with experience in obtaining a good sample for Sjögren’s diagnosis.
• An ultrasound of the salivary glands uncovers changes in the glands caused by Sjögren’s and helps define the severity of the syndrome. For some, this can be a substitute for the lip biopsy.
Best treatments now: A patient with Sjögren’s may be seeing multiple specialists, including an ophthalmologist, a dentist, a dermatologist and others, for treatment. A rheumatologist is the best type of doctor to serve as a quarterback of sorts to work collaboratively with all the specialists involved. The most common Sjögren’s treatments now include…
• Artificial tears and anti-inflammatory prescription eyedrops—cyclosporine (Restasis) and lifitegrast (Xiidra).
• Cholinergic agonist drugs, including pilocarpine (Salagen) and cevimeline (Evoxac), for dry mouth.
• Prescription-strength fluoride toothpaste to mitigate tooth decay.
• Antifungal medications or mouthwashes to treat thrush.
• Hydroxychloroquine (Plaquenil) for arthritis, fatigue and certain rashes.
• Immunosuppressant drugs, like methotrexate (Trexall), mycophenolate mofetil (CellCept) and azathioprine (Azasan)…the biologic rituximab (Rituxan)…and corticosteroids, to reduce inflammation in the body.
• Pain relievers, including acetaminophen (Tylenol), gabapentin (Neurontin) and duloxetine (Cymbalta), for joint, nerve and muscle pain. Topical diclofenac can relieve pain in large joints.
Sjögren’s patients often find that various natural treatments, such as massage, acupuncture and stress-reduction techniques, help their symptoms. An anti-inflammatory diet that includes plenty of whole fruits and vegetables, healthy fats, fiber and moderate amounts of organic meat…and eliminates or reduces trans fats, processed foods, preservatives and red meat may help as well.
Latest research: It’s hoped that new clinical trials will discern if existing disease-modifying antirheumatic drugs (DMARDs), used successfully for other autoimmune disorders, might also work for Sjögren’s. Arresting inflammation in the moisture-producing glands is the next big goal. To find clinical trials focusing on new treatments, go to info.Sjogrens.org/clinical-trials.